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Multiple aortic stenosis


 

Authors :
Carmen-Diana Botezatu2, Roxana Enache1,2, Pavel Platon2, Carmen Ginghina1,2, Bogdan A. Popescu1,2.

Authors details :

(1)"Carol Davila" University of Medicine and Pharmacy - Euroecolab, Bucharest, Romania.

(2)"Prof. Dr. C. C. Iliescu" Institute of Cardiovascular Diseases, Bucharest, Romania.

Description

  • 21 year old female (144 cm/39 kg) addmitted due to angina, shortness of breath and fatigue.
  • On auscultation high intensity holosystolic murmur in the aortic area.
  • Left ventricular hypertrophy on ECG

Clinical case information

http://www.youtube.com/watch?v=RrQ5REBfF2w
http://www.youtube.com/watch?v=7Z5QB8UDBMk
http://www.youtube.com/watch?v=gTi9hAZtMYU
Transthoracic echocardiography (TTE) revealed a tricuspid aortic valve with a particular cusp morphology and some opening impairment difficult to quantify on TTE

 

http://www.youtube.com/watch?v=HQ8HrBzJIeg
http://www.youtube.com/watch?v=E2aE5KjNLlc
The left ventricle was significantly hypertrophied and had normal global systolic function.

 

http://www.youtube.com/watch?v=Qa-WVbBUeQY
On color Doppler flow turbulence was observed, both proximal and distal to the aortic cusps.

 

CW Doppler
High velocities (6.5 m/s) were found at CW Doppler.

 

The evaluation of the aorta revealed small dimensions of the aortic root (14 mm; 11.2 mm/m2), and the sinotubular junction (8 mm; 6.4 mm/m2). The proximal ascending aorta measured 19 mm; 15.2 mm/m2.

 

http://www.youtube.com/watch?v=KC2iFGoyP98
http://www.youtube.com/watch?v=Q769-h5uscQ
Transesophageal echocardiography (TEE) revealed dysplastic aortic cusps with limited mobility. 3D TEE showed the valvular dome opening.

 

3D TEE also allowed the direct assessment of supravalvular stenosis (0.7 cm2 by planimetry).

 

Moreover a dilated left main coronary artery was seen on TEE.

 

http://www.youtube.com/watch?v=vfUywrM3LHw
Left main coronary artery and supravalvular aortic stenosis were confirmed on invasive angiography.

 

Conclusion

The case illustrates the utility of TEE and 3D TEE in the evaluation of valvular heart disease, with particular significance in clinical decision making in patients with obstacles in series, such as valvular and supravalvular aortic stenosis.